急诊输液室严重药物过敏反应的临床特点及干预措施调查  

Investigation of the clinical characteristics and interventions for drug-induced anaphylaxis in the emergency infusion room

作　　者：石齐芳 巴根 李蒙 郝卫文 孙昊 蒋桂平 周颖 张华忠 万金甫 乔洁 金花 谢敏 曹云 周娟 赵超 王梓皓 张劲松 Shi Qifang;Ba Gen;Li Meng;Hao Weiwen;Sun Hao;Jiang Guiping;Zhou Ying;Zhang Huazhong;Wan Jinfu;Qiao Jie;Jin Hua;Xie Min;Cao Yun;Zhou Juan;Zhao Chao;Wang Zihao;Zhang Jinsong(Department of Emergency Medicine,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Pharmacy,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院急诊医学中心,南京210029 [2]南京医科大学第一附属医院药学部,南京210029

出　　处：《药物不良反应杂志》2024年第12期715-719,共5页Adverse Drug Reactions Journal

基　　金：国家自然科学基金(82172184)。

摘　　要：目的调查急诊输液室严重药物过敏反应的临床特点及相关干预措施。方法基于南京医科大学第一附属医院(我院)急诊医学中心急诊输液室建立的药物不良反应数据库,收集2019年11月至2023年11月发生严重过敏反应患者的临床资料,包括性别、年龄、既往药物不良反应史、过敏史、Charlson合并症指数,用药情况,严重药物过敏反应相关信息(发生时间、临床表现),干预措施,转归,以及随访情况;分析这些患者的临床特征和干预措施。结果研究时段内,我院急诊输液室共398772例患者接受药物静脉滴注治疗,其中发生药物不良反应者625例,75例发生了严重过敏反应。发生严重过敏反应者占总输液患者的0.02%(75/398772),占发生药物不良反应患者的12.0%(75/625),其中Ⅱ级30例(40%)、Ⅲ级45例(60.0%),无Ⅳ级患者。75例严重过敏反应涉及药物多为抗感染药物(41,54.7%)。严重药物过敏反应临床表现多样,最常见的是心血管系统表现,主要为不同程度一过性的血压下降(67例,89.3%);其次是全身表现和神经系统表现,主要为大汗(31例,41.3%)和头晕(28例,37.3%)。75例严重过敏反应患者均给予停药、更换输液器、快速评估循环和呼吸及监测生命体征等措施处理,其中65例(86.7%)给予快速静脉滴注补液扩容,6例(8.0%)接受了糖皮质激素静脉注射,3例(4.0%)给予0.5 mg肾上腺素肌内注射,2例(2.7%)给予抗组胺药。75例患者均症状改善,未发现后遗症或死亡病例。结论急诊输液室中,严重药物过敏反应严重程度主要为Ⅱ级和Ⅲ级,及时干预预后较好;治疗措施以快速静脉滴注补液扩容为主,肾上腺素使用率较低。Objective To investigate the clinical characteristics and interventions associated with drug-induced anaphylaxis in the emergency infusion room.Methods Bases on the adverse drug reaction database from the emergency medicine center of the First Affiliated Hospital of Nanjing Medical University,clinical data of patients who experienced drug-induced anaphylaxis in the emergency infusion room between November 2019 and November 2023 were collected,including gender,age,history of previous adverse drug reactions,allergy history,Charlson comorbidity index,medication details,information related to drug-induced anaphylaxis(onset time,clinical manifestations),interventions,outcomes,and follow-up.The clinical characteristics and interventions in these patients were analyzed.Results During the study period,a total of 398772 patients in the emergency infusion room in our hospital received intravenous infusion of drugs.Of them,625 cases developed adverse drug reactions(ADRs)and 75 cases developed drug-induced anaphylaxis,accounting for 0.02%(75/398772)of the total infusion patients and 12.0%(75/625)of all ADR cases.Of the 75 patients with anaphylaxis,30 cases(40%)were classified as gradeⅡ,and 45 cases(60%)as gradeⅢ,with no gradeⅣcases.The most common drugs involved in 75 cases of anaphylaxis were anti-infective drugs(41 cases,54.7%).Drug-induced anaphylaxis exhibited diverse clinical manifestations,with cardiovascular symptoms being the most common,primarily varying degrees of transient hypotension(67 cases,89.3%),followed by systemic and neurological symptoms,including profuse sweating(31 cases,41.3%)and dizziness(28 cases,37.3%).All 75 patients with anaphylaxis were treated with measures such as discontinuation of medication,replacement of infusion sets,rapid assessment of circulation and respiration,and monitoring of vital signs,of which 65(86.7%)received rapid intravenous infusion for volume expansion,6(8.0%)received intravenous injection of glucocorticoids,3(4.0%)received intramuscular injection of 0.5 mg epinephrine

关 键 词：急诊处理 输液 静脉内 药物相关副作用和不良反应 肾上腺素 严重过敏反应 

分 类 号：R969.3[医药卫生—药理学]